Healthcare Provider Details

I. General information

NPI: 1801840079
Provider Name (Legal Business Name): ATLANTIC PHARMACY SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 06/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4908 SW 72ND AVE SUITE C
MIAMI FL
33155-5548
US

IV. Provider business mailing address

4908 SW 72ND AVE SUITE C
MIAMI FL
33155-5548
US

V. Phone/Fax

Practice location:
  • Phone: 305-666-8711
  • Fax: 305-666-9117
Mailing address:
  • Phone: 305-666-8711
  • Fax: 305-666-9117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH19714
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPH 23154
License Number StateFL

VIII. Authorized Official

Name: MR. EMERSON CARMONA
Title or Position: PRESIDENT
Credential:
Phone: 305-666-8711